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Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use.
Postgrad Med. 2013 Jul; 125(4):115-30.PM

Abstract

The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors. Few practice guidelines for BZD treatment are readily available, especially when they are combined clinically with opioid analgesics and other central nervous system-depressant agents. However, coadministration of these agents produces a defined increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential. In this article, we review the prevalence and pharmacologic consequences of BZDs and/or alcohol use among patients with pain on chronic opioid therapy, as well as the importance of urine drug testing, an indispensable tool for therapeutic drug monitoring, which helps to ensure the continued safety of patients. Regardless of risk or known aberrant drug-related behaviors, patients on chronic opioid therapy should periodically undergo urine drug testing to confirm adherence to the treatment plan.

Authors+Show Affiliations

Pain Management and Wellness Center, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA. healthmd@optonline.netNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23933900

Citation

Gudin, Jeffrey A., et al. "Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, And/or Alcohol Use." Postgraduate Medicine, vol. 125, no. 4, 2013, pp. 115-30.
Gudin JA, Mogali S, Jones JD, et al. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115-30.
Gudin, J. A., Mogali, S., Jones, J. D., & Comer, S. D. (2013). Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgraduate Medicine, 125(4), 115-30. https://doi.org/10.3810/pgm.2013.07.2684
Gudin JA, et al. Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, And/or Alcohol Use. Postgrad Med. 2013;125(4):115-30. PubMed PMID: 23933900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. AU - Gudin,Jeffrey A, AU - Mogali,Shanthi, AU - Jones,Jermaine D, AU - Comer,Sandra D, PY - 2013/8/13/entrez PY - 2013/8/13/pubmed PY - 2013/10/22/medline SP - 115 EP - 30 JF - Postgraduate medicine JO - Postgrad Med VL - 125 IS - 4 N2 - The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors. Few practice guidelines for BZD treatment are readily available, especially when they are combined clinically with opioid analgesics and other central nervous system-depressant agents. However, coadministration of these agents produces a defined increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential. In this article, we review the prevalence and pharmacologic consequences of BZDs and/or alcohol use among patients with pain on chronic opioid therapy, as well as the importance of urine drug testing, an indispensable tool for therapeutic drug monitoring, which helps to ensure the continued safety of patients. Regardless of risk or known aberrant drug-related behaviors, patients on chronic opioid therapy should periodically undergo urine drug testing to confirm adherence to the treatment plan. SN - 1941-9260 UR - https://www.unboundmedicine.com/medline/citation/23933900/Risks_management_and_monitoring_of_combination_opioid_benzodiazepines_and/or_alcohol_use_ L2 - https://www.tandfonline.com/doi/full/10.3810/pgm.2013.07.2684 DB - PRIME DP - Unbound Medicine ER -